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Living Independently Blog

Know Your Way Around Care: Medicare vs. Long-Term Care

medicareWhy Medicare is not intended as a long-term care coverage plan.

With all of the concerns and details that arise during the aging process, it’s easy to be confused about the difference between Medicare and long-term care. The confusion likely stems from the services that Medicare Part A, hospital insurance, will cover. Two of those are inpatient care in a skilled nursing facility (SNF) and home health care, common settings for long-term care.

The fact is that 70% of people over 65 will need some type of long-term care during their lifetimes. To clarify, long-term care means services and support for your personal care needs. Most long-term care is not medical.

And let’s be very clear: Medicare does not pay for long-term care expenses. Neither will Medicare health insurance or employer health insurance, for that matter.

If a person moves into a nursing home because he or she needs long-term care or a homecare agency sends an aide to the home to help a patient with bathing, why doesn’t Medicare pay? The simple answer: Medicare pays for care that is skilled, meaning that it requires the skills of a registered nurse, physical therapist, occupational therapist or speech-language pathologist.

What’s more, deductibles, coinsurance and copays still need to be paid, even for services that Medicare covers.

In addition, if the average non-medical person can provide the care without additional training, the care is not categorized as skilled and Medicare will not pay for it. With a program like Envisage, on the other hand, our team helps to coordinate services and support on your behalf so you won’t become a burden to family. And that’s a key benefit that’s included with your membership.

So, with all of this in mind, how can you start planning for long-term care?

Here are some beginning steps:

  1. Learn about long-term care, the different options, and what’s available in your community.

  2. Work with a trusted financial advisor to develop a plan to cover the costs. Consider these two scary statistics:
      • Fewer than 35% of Boomers have a plan for how they will receive care in retirement.
      • Almost 80% have no money set aside specifically for their long-term care needs.
  1. Determine who can play a role in your plan. Do not expect your family to be your sole source of support. Explore community resources and caregiving options like the Envisage membership program.

  2. Incorporate your wishes into the plan. Do you have an up-to-date will, advance health-care directive and durable power of attorney for health care? Include in your plan important financial information and your long-term care wishes.

  3. Share the plan with family members, health-care providers, and anyone else who needs to know.

Older adults who believe that Medicare will pay for long-term care – or that this care involves long-term care insurance or living in a nursing home – may be woefully unprepared for the future. It’s never too late to put together a long-term care plan and to develop your personal strategy for handling decisions in the future.